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California workers' comp system: FUBAR

We see it all the time in Rancho Mirage and across Coachella Valley: someone is hurt while on the job, but because they have never dealt with the California workers' comp system before, they find it to be a maze of acronyms, complex rules and bureaucratic doublespeak.

When they find themselves at odds with an insurer over their injury, they can feel lost. They disagree with the insurer over needed medical treatments, or a return to work, adjustments in work duties, etc., but they feel as if they've gone down a rabbit hole without a guide to explain the meanings of WCAB, QME, IMR, DWC, AME and all the rest of the alphabet soup.

Unfortunately, the letters in that alphabet soup stand for medical professionals, departments, forms and procedures important to the process of making sure that you get the treatments you need and the wage replacement you and your family depend on.

Let's take a quick look at some of those acronyms so beloved by bureaucrats:

  • WCAB: the seven-member Workers' Compensation Appeals Board reviews decisions by workers' comp administrative law judges, among its several functions
  • QME: qualified medical evaluator; a physician called in to evaluate you if there is a disagreement with your treating doctor  (note: a QME can be, according to the state of California, "doctors of osteopathy, chiropractors, psychologists, dentists, optometrists, podiatrists or acupuncturists")
  • IMR: independent medical review (you can request one if your doctor's prescribed medical treatment is not approved)
  • DWC: Division of Workers' Compensation
  • AME: the physician your workers' comp attorney and the claims administrator agree on

This short list of acronyms is just the TOTPI (tip of the proverbial iceberg). The state's website is overflowing with many more. An experienced attorney can help you understand the hearings, appeals procedures, people and processes important to your particular set of circumstances.

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